NEW YORK (Reuters Health) - Many patients with inflammatory bowel disease (IBD) perceive physicians as not being interested in the psychological impact of the condition on their lives, while one-third of doctors don't feel qualified to deal with patients' psychological problems, a new survey shows.

Up to 35% of IBD patients report anxiety and depression during remission, and during flare-ups up to 80% may be anxious and depressed, Dr. Ignacio Marin-Jimenez of the Hospital General Universitario Gregorio Maranon in Madrid and colleagues write. Depression has been linked to worse outcomes in IBD, while both stress and depression affect quality of life.

"Psychological remission should, therefore, be established as one of the objectives of treatment, as well as other targeted remissions, such as endoscopic, clinical or histological," they note in their report, online August 3 in Inflammatory Bowel Disease.

The new study is part of the ENMENTE project, which seeks to develop recommendations for diagnosing and treating mental health concerns in IBD patients. Dr. Marin-Jimenez and colleagues surveyed 903 patients and 170 gastroenterologists on how they saw the impact of psychological factors on the course and treatment of IBD.

Eighty-two percent of patients said their IBD got worse when they were anxious, and 67% said depression worsened their symptoms. Fifty-eight percent reported feeling sad or depressed during the course of their illness, while 51% reported anxiety.

Among physicians, 80% agreed that psychological issues have an impact on IBD patients. While 60% said they asked patients how the disease affected their work or emotions, more than 80% said they never asked about how IBD affected patients' sex lives.

Half of the doctors said that they always or almost always asked patients about their mental health, but patients said physicians addressed their concerns about psychological issues less than 25% of the time.

Both physicians and patients agreed that a psychologist should be part of the IBD care team. Patients and physicians also agreed that the most stressful aspects of IBD were managing fecal incontinence in public and using an ostomy bag. Patients also said that pain, fatigue and experiencing a new flare-up were harmful to their psychological well being.

"Interestingly, physicians appear to overestimate the anxiety of patients regarding most other situations," the researchers note. "Appropriate attention to these patient concerns requires providing adequate information and support, as this could minimize their impact. Actions such as making care available at short notice during a flare-up, using different strategies for handling incontinence situations or prescribing adequate rescue analgesia could reassure the patient, preventing the self-perpetuating cycle of worry-anxiety-flare-up."